Imperial Intimacies: Commodity Fetishism and the Global Organ Trade

“On the day of the operation, I felt like a Kurbanir goru, a sacrificial cow purchased for slaughtering on the day of Eid [the biggest celebration in the Islamic world].”

–Dildar, a 32-year old Bangladeshi rickshaw puller who sold one of his kidneys[1]

“Because you are poor, you will be gutted like an animal!”

–Okwe, in Dirty Pretty Things[2]

The scars left by organ transplant surgery never occur alone. Transplantation necessitates partnerships, openings and incorporations, intimacies. In Tsunami Nagar, a resettlement camp in India for refugees displaced by the 2004 disaster, nearly every adult woman has a foot-long scar. These traces of kidney removal operations (nephrectomies) proliferated in the aftermath of the tsunami, when “a few entrepreneurial hospitals and organ brokers saw the tragedy as an opportunity to make a fortune peddling the kidneys of refugees.”[3] Journalist Scott Carney writes that “over the years so many people had sold their kidneys in Tsunami Nagar that wry locals began calling the camp ‘Kidneyvakkam’ or ‘Kidneyville.’”[4]

These nephrectomy scars have counterpoints in thousands of other bodies located in wealthy communities all over the world. For anthropologists Jean and John Comaroff, the global organ trade is “a metonymic feature of the everyday and occult economies of ‘millennial capitalism,’” where new appetites and desires are cultivated by shifts in technology and production.[5] Carney observes that “…our appetite for human flesh is higher now than at any other time in history.”[6]

Like the connections between the scars of wealthy organ consumers and poor organ providers, a vast network of intimacies enables the functioning of the global organ trade. Though these intimacies are (re)produced by enduring legacies of colonial violence and new capital formations, some are highlighted while others are disavowed. For example, the successful operation of an organ transplant between an ailing wealthy man from London and a poor woman from Sri Lanka functions on his perceived lack of intimacy with this woman. His decision to seek out the literal (and highly intimate) incorporation of her body into his own is often animated by the moral claims he feels toward his family and friends, by his refusal to ask for the “sacrifice” of an organ exchange from one of his intimate loved ones. It is the privileging of some intimacies over others that pushes him to seek a kidney from a desperate organ provider. Ironically, it is this unacknowledged intimacy, not the intimacy he recognizes with his loved ones, that keeps his heart beating.

When entire villages exist of women with single kidneys, and flows of wealthy men from all over the world return home kept alive by the functioning organ of a poor person, questions about the ethics of “living together” in today’s world become inescapable. What does living together today mean when transnational exchanges intimately connect people through blood flows and heartbeats? What makes it possible for a wealthy patient to consider his relationships to his relatives “too intimate” to ask for an organ donation? What processes enable him to purchase a kidney from a “distant” poor Sri Lankan woman, and ultimately be kept alive by the intimacy that he must also disavow?

There are a variety of reasons why privileged consumers display unease, even moral indignation, at the thought of making such a claim on a family member or friend. This may partly be because of the seismic shifts that can occur in relationships when such a sacrifice is performed. In research for their book about organ transplantation, Renée Fox and Judith Swazey found there were numerous reasons patients didn’t want to ask loved ones for an organ, such as “the recipient may feel that because the relations between them are already tangled or strained receiving an organ from this individual would make the situation even more emotionally complicated and difficult,” or “the recipient may be heavily burdened by the realization that it is such an extraordinary gift that he or she will never be able to repay it.”[7] They noted that one woman “did not want her father to give her a kidney. She could not bear to be indebted to him for such a gift.”[8] Another patient, after receiving her brother’s organ, “refused to speak to her brother. She found that she resented that he had given her one of his kidneys, had tremendous guilt…”[9]

With anxieties about the debt of life itself threatening to destabilize bonds among family and friends, the logics of the market seem to penetrate all realms of intimate life. However, gross financial equality facilitates the acquisition of organs from the desperately poor, enabling organ recipients to live without having to encounter the sacrifice of the organ provider on an immediate level. Despite the highly intimate connection between both members of an organ transplantation, the sacrifice of the poor person’s body and the new intimacies created by the intermingling of bodies are disavowed, obfuscated.

When “medical mythology promises the ‘unprecedented possibility of extending life indefinitely with the organs of others,” a hierarchization of different bodies values some lives over others.[10] The global flow of body parts demonstrates the inequitable value and protection of life across differences in race, class, and gender. While organ transplantation has been framed as an “immortal promise” for wealthy people with access to medical services, for poor organ providers, it is often a detrimental process of bodily fragmentation that can leave them closer to death. The decision to avoid asking for a sacrifice from a loved one ultimately comes at the expense of receiving this sacrifice from another, a decision that is often defended through the unbreakable intimacy of the family. Ultimately, the recognition of intimacy is the primary justification for why wealthy transplant patients can’t bear to ask a family member or close friend for an organ donation. Anxieties about bonds of emotional debt among loved ones, coupled with the conditions of global inequality that can produce both the wealth of patients and the desperation of poor organ providers, ironically push people to seek out intimacies with other bodies over the intimacy of the family.

This multidimensional calculus between intimacies is what theorist Lisa Lowe calls the “political economy of intimacies,” a concept that highlights how historic and contemporary processes of empire coalesce to produce “a constellation of asymmetrical and unevenly legible ‘intimacies.’”[11] This “unsettles the meaning of intimacy as the privileged sign of liberal interiority or domesticity, by situating this more familiar meaning in relation to…the occluded ‘intimacies’ of slavery, colonialism, and imperial trade.”[12] In other words, colonialism, mass migrations, and the global routes of capital produce a myriad of intimacies that are alternately underscored and obfuscated to produce the notions of affiliation and connection that undergird liberalism’s modern subjectivities. The intimacy of the family is privileged over the intimacy created by gendered, racial capitalism between the organ consumer and the organ provider.

Furthermore, attentiveness to the political economy of intimacies illuminates how conceptions of love and connection are implicated in the violence of the global economy. Elizabeth Povinelli asks, “How do we practice our deep, thick everyday lives so that we continually perpetuate the way that liberalism governs difference, even when we seem to be doing nothing more that kissing our lover goodbye?”[13] For Povinelli, “The intimate event is an anchor point because it seems…to be the densest, smallest knot.”[14] How, then, can teasing out the knot of co-entangled and co-productive intimacies in the global organ trade shed light on “modern forms of dispossession, exploitation, repression, and their concrete impacts on the people most affected by them and on our shared conditions of living?”[15] What occluded histories and subjectivities haunt the intimate moments of bodies produced by the liberal settler state? What can the organ trade tell us about the violences required to (re)produce these intimacies?

These “occluded intimacies” occur literally in the flesh in the global organ trade, in which, “The historical relationship of conquest, colonization, and extraction has shaped the transformation of actual…bodies into raw materials in their own right. The outcome is a serious form of exploitation…where impoverished populations become organ suppliers to prolong lives for the…few.”[16] The flows of the organ trade span the entire globe, with commercial connections between Brazil and South Africa, Israel and Moldova, Germany and Turkey, China and the United States, and beyond; the circulation transgresses national and continental borders. Indeed, “Globalization has made the speed and complexity of these markets bewildering.”[17] However, as Scott Carney notes, “The one rule with organ markets is that human tissue moves up-and never down-the social hierarchy.”[18] Nancy Scheper-Hughes, a medical anthropologist, echoes this sentiment, writing that “in general, the flow of organs follows the modern routes of capital: … from poor to rich, from black and brown to white, and from female to male.”[19]

Amidst increasing global financial crises and expanding precarity, “poor people around the world often view their organs as a critical social safety net.”[20] As elaborated by researcher Lawrence Cohen, “It is not that every townsperson actually knows someone who has been tempted to sell a vital part of the self but the idea of the ‘commodified’ kidney has permeated the social imaginary. ‘The kidney [stands]…as the marker of one’s economic horizon, one’s ultimate collateral.’”[21] In fact, many people that Cohen interviewed in India spoke “matter-of-factly about when it might be necessary to sell a ‘spare’ organ.”[22] In her ethnographic work, Scheper-Hughes discovered that many “women had sold a kidney to feed the family, the most common explanation given by kidney sellers world-wide.”[23] This is supported by an advertisement published in the Brazilian newspaper Diario de Pernambuco, which detailed: “I am willing to sell any organ of my body that is not vital to my survival and that could help save another person’s life in exchange for an amount of money that will allow me to feed my family.”[24]

Even when many organ providers know they will not ultimately receive the full compensation promised by their brokers, desperation pushes many to decide to move forward with the extraction regardless. During his fieldwork, anthropologist Monir Moniruzzaman found that “most sellers (27 out of 33 sellers) do not receive the full amount of money they had been promised.”[25] Even when initial cash payouts are collected, the majority of people who sell organs quickly fall back into poverty. For Egyptian providers, 81% spent their cash payouts within 5 months, most of which went toward paying off financial debts.”[26] Iranian providers experienced an income decline between 22% and 66%, while 65% of kidney providers noted an overall negative effect on their employment. In Moldova and the Philippines, organ providers experienced large degrees of unemployment after returning from their operations, partly because of physical debilitations.[27] In fact, the lack of medical care and susceptibility to other complications often means that the physical after-effects of organ transplant surgery are so detrimental that it affects people’s ability to return to work, demonstrating that the global organ trade is not only a question of lives, but a question of livelihoods. Scholar Gerard Boyce observes that, for most people, “The removal and sale of a kidney is likely to reduce their primary productive asset—physical strength.”[28]

This transnational network updates Marx’s visions of vampiric nineteenth century capitalism through a system of commodified life-extension that functions by “sapping the health and strength from ghettos of poor donors and funneling their parts to the wealthy.”[29] Contemporary capitalism not only produces reserve armies of laborers, but the macabre vision emerges of reserve armies of “spare parts.” This implicates the logic of capital in the very functioning of organ exchange, from the financial precarity that pushes people to sell their organs to the subsequent processes of commodification. Yet the market for organs is often framed as abberrational, even scandalous, among other normalized modes of production. Scott Carney, for instance, continually highlights the exceptional nature of the organ trade, writing that “markets in flesh are different because their customers owe their lives and family relationships to the supply chain.”[30] For Carney, an organ, unlike “other capitalist commodities, which ideally retain no element of workers’ personal engagement when they [go] to market,” cannot fully efface its production process.[31] In other words, the scars persist.

Carney’s unease is edifying, for it appears to be the explicitness of the intimacies that have him so disturbed. He writes, “When we buy a body part, we take on the liabilities for where it came from both ethically and in terms of the previous owner’s biological and genetic history. It’s a transaction that never really ends.”[32] The physicality of the organ, its biomass, and the scars it leaves in its wake make it, in Carney’s words, an “uncomfortable” commodity.[33] These traces make an alienated organ more resistant to the processes of commodity fetishism that efface the violent production processes of other global commodities, such as clothing and coffee. And this is perhaps the true scandal of the global organ trade—it makes explicit the intimacies, the violences, and the connections that undergird all modern modes of production.

For anthropologist Anna Tsing, “aberrational” markets like the organ trade are important to explore because “their scandalous status allows us to see them; they do not collapse into the taken-for-granted status of capitalist discipline. This is a Conradian Heart of Darkness moment, where the horror of how capitalist commoditization works is laid bare.”[34] Ultimately, the global organ trade enables us to see a larger truth about contemporary capitalism—that beneath the commodity fetishisms and complex erasures are markets of inestimable horror.

Bangladesh, for example, doesn’t just produce organs for circulation in the global economy, but also clothing. While “organ classifieds reach millions of poor rickshaw pullers, day laborers, slum dwellers, and village farmers, some of whom eventually sell their body parts to get out of poverty,” many classifieds for jobs in the garment industry also reach these same “poor rickshaw pullers, day laborers, slum dwellers, and village farmers.”[35] On April 24, 2013, just outside of Dhaka, the Rana Plaza clothing factory collapsed, crushing 1,127 people to death.[36] To what extent were these people also pushed to desperately “sell their body parts to try to get out of poverty?” What connections exists between the villages of women with missing kidneys, and the villages of missing women, whose bodies were buried under a collapsed factory?

What makes the violence that underpins the mass production of commodities like clothing any less than the violence that enables the global organ trade? The “strange alchemy that happens when we decide that a human body [part] can be swapped on the open market” is the same alchemy that occurs when any produced object goes to market.[37] While Carney believes that the purchase of an organ is “a transaction that never really ends,” what if we looked at all exchanges, both ethically and in terms of intimacies with histories of production and circulation, as transactions that never really end?[38]

The scars that accompany organ transplantation attest to a past violence and residual trauma, of an absence that is also a presence. They haunt, thwarting attempts to efface the myriad intimacies that criss-cross our world by confounding assimilation into the amnesiac project of Western modernity. When, as artist Kader Attia says, “modernity is about making wounds disappear,” scars are the specters that haunt and interrupt these processes of effacement.[39]

Whether they admit it or not, wealthy people all over the world are haunted by intimacies with refugee women and poor day laborers that flow through their veins, by the echo of a matching scar on a different body that is both impossibly far away and devastatingly intimate. The very conception of a “self” is unsettled by these connections because, as sociologist Avery Gordon writes, “Subjectivity is always and inevitably haunted by the social and most especially by those repressions, disappearances, absences, and losses enforced by the conditions of modern life.”[40] This requires liberalism’s privileged subjectivities, of the “family” of the “sovereign self,” to continually disavow infiltrated intimacies, to continually repress all traces of that which is “other.” However, these traces, perhaps in the form of scars, or in the handwritten notes of protest slipped by factory workers into the pockets of mass-produced clothing, are always already emerging to haunt modernity’s effacements.[41] Indeed, Gordon writes that “haunting is one way in which abusive systems of power make themselves known and their impacts felt in everyday life, especially when they are supposedly over and done with (slavery, for instance) or when their oppressive nature is denied (as in free labor or national security).”

When the inconceivability of violent connections is the precondition for smooth consumption, what would it mean to account for all the intimacies that underpin the contemporary economy? Avery Gordon, speaking on Fredric Jameson, argues that it would be overwhelming. She writes that modern consumers are kept busy just surviving in the confusing supermarket of life, itself already having coded and decoded all exchanges, reification—the effacement of the traces of production—appears, in this milieu, to be the welcome relief one hopes for. Jameson puts it well: ‘the point of having your own object world, and walls and muffled distance or relative silence all around you, is to forget about all those innumerable others for a while.’ To remember ‘would be like having voices inside your head.’ It would be like having voices inside your head because a postmodern social formation is still haunted by the symptomatic traces of its productions and exclusions.[42]

* * *

To be privy to all the intimacies that are the conditions of life, then, is not only overwhelming, it is terrifying. It is to apprehend the myriad bodies that intimately haunt every act of consumption. Haunting is disorienting and strange, it is hearing utterances and encountering figures that modern capitalism has attempted to render unsensible. Haunting entails an estrangement from the self, from the family, from the known, because the encounter of haunting is always an intimate encounter with the other.

While the expropriation of organs from poor bodies into the socially privileged is a horrifying feature of the global economy, it is ultimately the spectacularization of violences that are indeed integral to contemporary modes of production. In the words of Jacques Derrida, “Is not the spectacle of this murder, which seems untenable in the dense and rhythmic briefness of its theatrical moment, at the same time the most common event in the world? Is it not inscribed in the structures of our existence to the extent of no longer even constituting an event?”[43] The “non-event” of the violence of the global economy is the routinization of a “sacrificial economy” where “incalculable sacrifice” lies behind the “smooth functioning” of society.[44] The horror of this mass death is effaced through the political economy of intimacies, which highlights some intimacies while disavowing others in order to continually reproduce divisions between self and other, between loved ones and expendables. This disavowal, “whose resources,” Derrida points out, “are inexhaustible,” means that privileged intimacies are always already haunted by the sacrifice of the effaced “other.”[45] This is a human sacrifice that is, according to Derrida, inscribed into the foundations of contemporary society. He writes that “because of the structure of the laws of the market that society has instituted and controls, because of the mechanisms of external debt and other comparable inequities, that same ‘society’ puts to death or (but failing to help someone in distress accounts only for a minor difference) allows to die of hunger and disease tens of millions…Not only does such a society participate in this incalculable sacrifice, it actually organizes it. The smooth functioning of its economic, political, and legal order, the smooth functioning of its moral discourse and good conscience, presuppose the permanent operation of this sacrifice.[46]

The logics that enable a system’s “smooth functioning” and reproduction of a “permanent operation” are both evident in the global organ trade, in which the sacrifice of some bodies over others is justified through a hierarchization of intimacies. The privileged intimacies under this system, then, are always implicated in a kind of putting to death. Yet the traces of this violence reappear, ghost-like, in the scars that accompany organ transplantation. Tracing the political economy of intimacies in the organ trade shows how the disavowed intimacies of production processes constantly haunt global commodities. These material bearers of the hidden relationships and power dynamics that define the global economy mean that moments of consumption are constantly haunted by the occluded intimacies. Since it is almost impossible to avoid contact with commodities on a daily basis, we touch and are touched by the violence of capitalism even in our intimate moments, even when we are just sipping coffee, sending a text message to a friend, or pulling a shirt over our shoulders. These objects contain intimacies with the violent histories of colonialism, slave plantations, national revolutions, and omnipotent economic power.

To feel these intimacies as “haunting” is to engage in a relationship with social violences that is not premised on modernity’s terms of occlusion and disavowal. Like the scars that persist after organ transplantation, haunting speaks to the traces of violence that cannot be easily assimilated into modernity’s amnesiac machine. Haunting, as Avery Gordon writes, is

an animated state in which a repressed or unresolved social violence is making itself known, sometimes very directly, sometimes more obliquely. I used the term haunting to describe those singular yet repetitive instances when home becomes unfamiliar, when your bearings on the world lose direction, when the over-and-done-with comes alive, when what’s been in your blind spot comes into view.[47]

* * *

Scars are uncanny because they speak to the traumatic history of a body, and the scars of the global organ trade make explicit the violent connections that exist among different bodies in today’s world. Furthermore, tracing the political economy of intimacies within this network of bodies opens new possibilities for the apprehension of other violences in other processes of production. Though other commodities are not accompanied by the physical scars that organ exchange entails, haunting presents an alternative modality to apprehend the violent intimacies that are effaced by fetishism.

Haunting as an engagement is inherently anti-epistemological (the effacements of the production process make it literally impossible to know the other though the commodity form) but rather emphasizes disorientation, loss, discomfort, and disturbances. An alternative modality of relation to global intimacies and one that isn’t premised on violent obfuscation, haunting interrupts the economy that undergirds the political economy of intimacies. This interruption is ultimately a loss of the system of values that push organ seekers to privilege their familial intimacy over the intimacy that they share with an organ provider. Of this loss, Derrida writes that “the sacrifice of economy…is indeed in this case the sacrifice of the oikonomia, namely of the law of the home (oikos), of the hearth, of what is one’s own or proper, of the private, of the love and affection of one’s kin.”[48] Derrida is saying that to lose the economy of intimacies means to lose the privileging of intimacies that have been inscribed by contemporary and historical processes of domination. This loss is premised on a loss of the terms of engagement that define modern distributions of violence.

Haunting, by estranging the normal, by evoking violences that are supposedly hidden and buried, can engender this loss. To be haunted by global intimacies, then, is to lose oikonomia, to embrace those “repetitive instances when home becomes unfamiliar, when your bearings on the world lose direction.”[49] Furthermore, haunting acts as a force of unrest that demands response, demands action. Expounding on the mobilizing power of haunting, Gordon writes:

“Haunting is a frightening experience…But haunting…is distinctive for producing a something-to-be-done. Indeed, it seemed to me that haunting was precisely the domain of turmoil and trouble, that moment (of however long duration) when things are not in their assigned places, when the cracks and rigging are exposed, when the people who are meant to be invisible show up without any sign of leaving, when disturbed feelings cannot be put away, when something else, something different from before, seems like it must be done.[50]

Ultimately, haunting presents alternative imaginaries for “living together” by interrupting the processes of commodity fetishism that are crucial to capitalist functioning. When the occluded intimacies of modernity emerge as visions of horror, when the familiar becomes strange and unrecognizable, it becomes impossible to live as one has before. Haunting is a demand, a demand for a world where scars and wounds can no longer be invisible.

Bailey Miller was a student in the Political Science department at Vassar College. She is currently studying Arabic in Granada, Spain.